A Community-Based Approach to Improving Oral Health in Virginia

Our Stories from the Field series highlights how communities across the nation are addressing the Healthy People 2020 Leading Health Indicators (LHIs). LHIs are critical health issues that — if tackled appropriately — will dramatically reduce the leading causes of death and preventable illnesses.

This month’s story features a program that is tackling the Oral Health LHI:

Children, adolescents, and adults who visited the dentist in the past year (OH-7)

Tooth decay is one of the most common chronic conditions affecting children in the United States. When it’s not treated, tooth decay can cause pain and infections — and may interfere with a child’s ability to eat, talk, learn, and play.

One evidence-based strategy for preventing tooth decay in children is the use of dental sealants — thin coatings that are painted onto the chewing surfaces of the back teeth. Studies in children show that sealants can reduce tooth decay in permanent molars by 80% for 2 years after placement, and they keep protecting against 50% of cavities for up to 4 years.

Bringing Oral Health Care to Schools
The Dental Health Program team at the Virginia Department of Health (VDH) knew that children’s oral health was an important issue to address in their state. In 2009, a Basic Screening Survey found that 47.4% of third grade children in Virginia had a history of tooth decay and 15.4% had untreated tooth decay.

Sharon Logue is the Sealant Program Coordinator in the Dental Health Program at VDH. “Our goal was to increase access to oral health care for high-risk children in targeted, mostly rural, areas across our state,” she says. The VDH team developed a very effective way to reach those kids in need: they brought preventive oral health care straight to their schools.

The year the Basic Screening Survey was released, VDH received a workforce grant from the Health Resources and Services Administration (HRSA) to pilot a school-based dental sealant program model. They continued this work under a grant from the Centers for Disease Control and Prevention (CDC) that supported the infrastructure for the program starting in 2013. What began as a sealant program has since expanded to include other preventive oral health services like fluoride varnish, dental screenings, referrals, oral health education, and even — in a few schools — teeth cleanings.

Making the Most of Remote Supervision
In order to bring dental care to Virginia schools, VDH needed to use a remote supervision model. “That way, a dentist doesn’t have to examine children before they get sealants,” says Tonya Adiches, Dental Health Programs Manager at VDH and part of the original program team. “This model allows us to send teams of dental hygienists and assistants straight to the schools to provide the evidence-based preventive services that we know work.”

Logue and Adiches explain that a regulatory change was needed in order to make their program a possibility because remote supervision protocol was new to Virginia. In 2012, the remote supervision protocol was approved by the Virginia General Assembly — and the VDH team was thrilled. “It allowed a more cost-effective means for getting these children the preventive oral health care they need,” says Adiches.

Reaching More Children
Since the VDH program sought to help at-risk children, the team decided that schools needed at least a 50% participation in the National School Lunch Program (NSLP), a federal meal assistance program, for inclusion in the oral health program. In the pilot phase, which ran from 2009 to 2012, the sealant program was only available to children of certain ages who were enrolled in the NSLP. But in 2013, the VDH team decided to offer preventive dental services to all children in the qualified schools.

“When we opened the program to all students, we were able to catch those kids who had never had sealants on any of their teeth before — and we removed the barrier of parents having to divulge that their kids were in the NSLP,” says Logue. “That helped us get care to more at-risk kids.”

Success by the Numbers
In the 2015–2016 school year:

A total of 6,866 children from 144 schools received dental services including sealants, fluoride varnish, dental screening, and follow-up care.

The number of schools enrolled in the sealant program was 103% higher than in 2012–2013.

The number of children who received sealants was 91% higher than in 2012–2013.

Additionally, as of the 2014–2015 school year:

Over half (52%) of third graders in Virginia had at least 1 dental sealant, which is significantly higher than the national average.

Utilizing Community-Minded Staff
When Logue, who now supervises the sealant program, discusses its success to date, she emphasizes the importance of the hygienists and assistants who do the work. Right now, VDH has 9 teams working across the state, supervised remotely by a public health dentist.

“You have to find the right folks,” Logue says. “Our teams work long days with lots of travel. They set up portable dental equipment in classrooms, cafeterias, school nurse offices, or on auditorium stages. This certainly isn’t your traditional dental hygiene position.”

The staff even promotes the program at first-of-the-year school nights or PTA events. “They have to get creative,” explains Logue. “Kids need parental consent to get our services, so reaching parents is key.”

Adiches adds how important it is to get potential stakeholders on board with the program. For example, VDH contacts private dentists to ask if they want to be on referral lists. “You need to make people understand that you’re not out there competing. This is about reaching kids who don’t have a regular dentist and establishing a dental home in their community.”

Looking Ahead
Response to the school-based program has been very positive, and the VDH team has high hopes for the future. According to Logue, “The longer a team is in an area, the more they connect to other community-based programs.” This opens up doors in terms of work they can do in the future, even beyond providing services to children. “In addition to their clinical work, our teams have become resources for whole communities,” she says. “We’ve had staff come back with all kinds of suggestions for expanding our reach.”

Examples include facilitating oral health education programs at drug treatment centers, running sessions on children’s oral health for new moms at local health departments, and providing oral health care trainings for nursing assistants at assisted living centers. “The teams are taking a lot of initiative and are truly invested in the communities they serve,” Logue says. “That’s really exciting to watch.”